Patients recovering from life-threatening conditions in intensive care may also have to battle psychological illness, a psychologist says.

A paper in the British Journal of Medical Psychology claims between 10% and 20% of people in intensive care or high dependency units develop such problems.

The psychological needs of patients are often overlooked as they do not improve life expectancy

Dr Ian Bennun, clinical psychologist

These range from anxiety to nightmares and from flashbacks to delusions.

Signs of psychological problems can include changes in behaviour such as aggression, passivity or non-compliance with treatment.

Patients in such units are often extremely shaken having nearly died.

Factors such as losing track of the difference between day and night or strong medication can also disorientate patients.

Those whose breathing is being controlled artificially can feel out-of-control, panic-stricken and anxious.

Other patients can become depressed and withdrawn.

Psychological needs

Some leading intensive care doctors say it is unhelpful to label this wide rage of symptoms as an Intensive Care syndrome".

But Dr Ian Bennun, a clinical psychologist at Torbay Hospital in South Devon who wrote the paper, said it should not be overlooked.

"The psychological needs of patients are often overlooked as they do not improve life expectancy - but they need to be considered as well as the patient's physical needs.

"There is also evidence that the family and friends of patients can develop problems if they are not involved in the care of a loved one who has a potentially life-threatening condition," he said.

That can happen if relatives spend a lot of time there, particularly in the cases of parents of young children who often "move in" to an intensive care unit (ICU) while their child is ill.

He added: "Part of the problem is the fact that in an intensive care unit there is no day or night, there is constant noise and many patients have marked sleep disturbance.

"Sometimes lights are not dimmed at night."

He said he had even been to ICUs where there were no windows, so patients had no idea of what time of day it was.

Prediction problems

Dr Bennun told BBC News Online research was needed to discover why some people were affected by the syndrome, while others were not.

"Predicting which patients are at risk is very difficult," he said.

He said one way of dealing with the problem was to have a clinical psychologist on hand, as happens in Torbay.

Other measures he suggested include making a difference between day and night to give people a sense of time in units which are constantly on the go.

Unhelpful

Dr Richard Griffiths, a member of the council of the Intensive Care Society said labelling the range of psychological problems patients suffer during ICU as 'ICU syndrome' or 'ICU psychosis' was "unhelpful".

He added: "Unfortunately much of what is said is not
based upon hard research evidence.

"What needs to be done is hard scientific research to understand the cognitive and psychological changes and progress throughout the illness and recovery period."

He said it was "a joke" to suggest that a psychologist needed to be constantly on hand.

"The psychological care of an ICU patients is no more or less important than the physical care and is something ICU doctors and nurses take very seriously."

Maura McElligott, a member of the Royal College of Nursing's critical care forum, said nurses were heavily involved in helping patients who showed psychological problems while on ICU.

She said: "Rather than fragmenting the care further by involving psychologists, it is better to liase with nursing staff, who can provide this kind of care."